New NHS children’s gender clinic hit by disagreements and dismissals
A series of redundancies from a team preparing to launch the NHS’s new gender clinic for children has further complicated plans to open the services in April.
Disagreements over the text of a training module for medical recruits for the new gender service have prompted NHS England to remove the training materials project from a team at Great Ormond Street hospital and outsource it to the Academy of Medical Royal Colleges.
Great Ormond Street last year recruited a small team, including paediatricians and child psychologists, to write training guidelines for new medical staff who will work in NHS England’s reformed gender services for children and young people.
But at least four members of the team resigned late last year after disagreements over how to treat children with gender dysphoria, according to sources close to the process.
The new NHS Children’s and Young People’s Gender Service for London will open its doors to patients in early April, a year later than initially planned and almost two years after NHS England announced the closure of the Gender Identity Development Service (Guide) for children in the Tavistock clinic in North London.
The Tavistock was founded thirty years ago to help children and other young people struggling with their gender identity. But following a series of concerns and complaints from inspectors, whistleblowers, patients and families, the clinic is to close and be replaced by a number of hubs, including on Great Ormond Street.
Great Ormond Street is working with Evelina Children’s Hospital and South London and Maudsley NHS Trust to trial the first of several regional hubs that will take over the work previously carried out by the Tavistock clinic.
The team of experts recruited to write the training material included former Tavistock staff who left because of concerns about that service’s treatment of young people, plus other doctors said to be opposed to the NHS’s new approach for dealing with children and young people with gender dysphoria.
Sources close to the discussions said there was “no consensus” within the team and that their work was incomplete when the members resigned.
In 2022, Dr Hilary Cass, the pediatrician charged with reviewing the NHS’s care for children with gender dysphoria, said a “fundamentally different” approach was needed due to increasing referrals and a significant change in the case mix, with a sharp increase in the number of adolescent girls. present with gender incongruity in their early teens.
She also noted that many children presented with a wide range of other complexities, including mental health needs. Her independent assessment highlighted the uncertainties surrounding the use of hormone treatments. Interim NHS service specifications say the new clinics will take a multidisciplinary approach and provide psychological support.
Some physicians working on the new training materials reportedly felt it was important to affirm a patient’s gender identity and believed that patients could benefit from medication. Others, some of whom resigned from their positions, emphasized the need to adhere to Cass’s recommendations and take a holistic, “exploratory” approach.
A spokesperson for the Academy of Medical Royal Colleges said the body had agreed to write an interim training module and was working to meet a six-week deadline, “as our members are keen to help ensure this service can go live as planned” (in April).
He added that because “time is tight”, the body would conduct introductory training to help doctors start seeing patients, and a more in-depth program would be initiated at a later stage.
Great Ormond Street said the team recruited to develop the training and education program “had now completed its part of the process and produced a range of high-quality materials. The program has now been passed on to the Academy of Medical Royal Colleges who will complete and deliver the induction programme.”
Some parents are turning to private healthcare, frustrated by ongoing unrest and NHS waiting lists, which can stretch to several years.
This week, a private hormone clinic for transgender young people said it had become the first British private provider to be registered by the health regulator, the Care Quality Commission, to prescribe cross-sex hormones to patients over the age of 16.
The service is part of the Gender Plus group, run by several ex-NHS former Tavistock doctors, which also offers psychological consultations and, for those over 18, referrals for gender confirmation surgery.